Provider Demographics
NPI:1801267703
Name:CHAMPION REHABILITATION AND SUPPORT SERVICES PLLC
Entity type:Organization
Organization Name:CHAMPION REHABILITATION AND SUPPORT SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SILAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:972-755-9765
Mailing Address - Street 1:PO BOX 703975
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-3975
Mailing Address - Country:US
Mailing Address - Phone:972-755-9765
Mailing Address - Fax:214-602-3260
Practice Address - Street 1:5068 W PLANO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4409
Practice Address - Country:US
Practice Address - Phone:972-755-9765
Practice Address - Fax:214-602-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-18
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110891261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities